Tag Archive for: minor medical

What Does Minimum Essential Coverage Entail?

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HIPAA vs FERPA: What’s the Difference?

There are laws in place to protect the privacy of patients and students. Continue reading to learn the difference between HIPAA and FERPA.

What is HIPAA? 

HIPAA stands for Health Insurance Portability and Accountability Act of 1996. Under this federal law, patient health information is protected and kept secure unless the patient gives consent to disclose their information. The patient has control of who has access to their records. 

It’s a national mandate to keep protected health information (PHI) secure. At its core, HIPAA regulates the privacy of health information on a national level. 

PHI includes:

  • Your name
  • Your address
  • Your Social Security Number 
  • Medical records 
  • Any unique identifiers 

For example, if parents of a college student call their child’s doctor for an after-visit summary, the office will not be able to disclose any information without the child’s consent. 

Who has to Follow HIPAA Rules? 

Any entity that falls under the category of “covered entities,” must always enforce HIPAA law. These include:

  • Health care providers
  • Health Care Clearinghouses 
  • Health Care Plans
  • Business Associates 

Why is HIPAA Important 

HIPAA keeps personal information secure for patients. It helps build trust between the entity holding private medical information and the patient. Allowing patients the choice to disclose records to whoever they decide keeps sensitive information safe from landing in the wrong hands.  

HIPAA Violations Examples 

HIPAA violations breach patient confidentiality and can result in fines and penalties. Common violations include: 

  • Cyber-attacks or breaches in security 
  • Lack of data encryption 
  • Sending the wrong PHI to a patient 
  • Discussing PHI outside of work 
  • Posting PHI on social media 
  • Theft of equipment that has PHI 
  • Incorrectly disposing of patient records 

What is FERPA

FERPA stands for the Family Educational Rights and Privacy Act that was implemented in 1974. This law is another federally mandated law that regulates the privacy of student information on a national level. It protects the privacy of student school records that the education system holds. 

Parents or legal guardians have access to the records and can have the records amended, and have the ability to disclose personally identifiable information from education records to their discretion until the student is 18 years old. 

According to the CDC, FERPA serves these two main purposes:

  1. “Gives parents or eligible students more control of their educational records. 
  2. Prohibits educational institutions from disclosing ‘personally identifiable information in education records’ without written consent.” 

Who Has to Follow FERPA Rules?

Any of the following public and private education systems are required to follow FERPA policy when they receive federal funding:

  • Elementary schools 
  • Secondary schools 
  • Post-secondary schools 
  • State and local education agencies 

Why is FERPA Important? 

FERPA is important because it allows students, parents, and legal guardians the ability to review school records, request any corrections that need to be made, and control who has access to the student’s personal identification information.

The education system must request consent from the student, parent, or legal guardian before releasing any personally identifiable information to keep the student’s information safe from the wrong hands. 

FERPA Violations Examples 

The federal government will revoke federal funding to education systems that violate FERPA regulations. Common FERPA violations include: 

  • The education system refuses to provide school records to the student, parents, or legal guardians.
  • School employees who, even unintentionally, disclose the academic standing of one student to other students. 
  • Telling parents about other child’s academic standing that is not their own. 
  • Posting student grades in public places with their names attached 
  • Allowing a parent volunteer to grade the exams of other students

HIPAA VS FERPA

Both HIPAA and FERPA are nationally mandated laws that protect information. HIPAA keeps medical records secure while FERPA keeps education records private. Failure to comply with either results in fines, penalties, or revocation of funding. 

Are you concerned with the HIPAA compliance of your virtual doctor’s appointment? Read about the HIPAA compliance standards that Zoom upholds to ensure your personally identifying information is kept safe in this article.

For more information about protected health information, read our article here.

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Preventative Services Covered by Minor Medical

Minimum essential coverage is health insurance that meets the Affordable Care Act requirements. Employers have a requirement to offer at least Minimum Essential Coverage to any benefit-eligible employee. Non-compliance can result in a penalty of $214.17 PER eligible employee per month without coverage.

At Innovative HIA, we aim to offer affordable, flexible, and compliant coverage for all employers.

What Does Minor Medical Cover?

Our Minor  Medical plans cover 100% of preventive services and wellness visits to the doctor. In addition, all members have access to 24/7/365 telehealth services and discounts on generic and brand prescriptions. 

These plans are the most affordable option under Minimum Essential Coverage. 

What Does Major Medical Cover?

Major Medical covers the preventative services and wellness visits mentioned above, as well as primary care and specialist visits with a $15 copay. As well as urgent care, labs, and X-rays with a $50 copay. 

24/7/365 telehealth services are included under this plan, along with access to behavioral health telehealth services

Prescriptions under the Major Medical plan are covered based on your coverage tier.

*$50 fee max 3 per year

Preventative Services Covered Under Minor Medical

Both plans cover preventative services and wellness visits. The services covered depend on age and gender. Here’s a look at the coverage offered under preventative services:

Covered Preventative Services for Adults

  • Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked
  • Alcohol misuse screening and counseling
  • Aspirin used to prevent cardiovascular disease in men and women of certain ages
  • Blood pressure screening for all adults
  • Cholesterol screening for adults of certain ages or at higher risk
  • Colorectal cancer screening for adults over 50
  • Depression screening for adults
  • Diabetes (Type 2) screening for adults with high blood pressure
  • Diet counseling for adults at higher risk for chronic disease
  • Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over
  • Hepatitis B screening for people at higher risk
  • Hepatitis C screening for adults at increased risk, and one time for everyone born 1945 –1965
  • HIV screening for everyone ages 15 to 65, and other ages at increased risk
  • Immunization vaccines for adults — doses, recommended ages, and recommended populations vary: Hepatitis A, Hepatitis B, Herpes Zoster, Human Papillomavirus, Influenza (flu shot), Measles, Mumps, Rubella, Meningococcal, Pneumococcal, Tetanus, Diphtheria, Pertussis and Varicella
  • Lung cancer screening for adults 55 – 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  • Obesity screening and counseling for all adults
  • Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
  • Statin preventive medication for adults 40 to 75 years at higher risk
  • Syphilis screening for all adults at higher risk
  • Tobacco use screening for all adults and cessation interventions for tobacco users
  • Tuberculosis screening for certain adults with symptoms at higher risk

Covered Preventative Services for Women

  • Anemia screening on a routine basis for pregnant women
  • Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer (counseling only; not testing)
  • Breast cancer mammography screenings every 1 to 2 years for women over 40
  • Breast cancer chemoprevention counseling for women at higher risk
  • Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
  • Cervical cancer screening
  • Chlamydia Infection screening for younger women and other women at higher risk
  • Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.”
  • Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before
  • Domestic and interpersonal violence screening and counseling for all women
  • Folic acid supplements for women who may become pregnant
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
  • Gonorrhea screening for all women at higher risk
  • Hepatitis B screening for pregnant women at their first prenatal visit
  • HIV screening and counseling for sexually active women
  • Human Papillomavirus (HPV) DNA Test every 5 years for women with normal cytology results who are 30 or older
  • Osteoporosis screening for women over age 60 depending on risk factors
  • Preeclampsia prevention and screening for pregnant women and follow-up testing for women at higher risk
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
  • Sexually transmitted infections counseling for sexually active women
  • Syphilis screening for all pregnant women or other women at increased risk
  • Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users
  • Urinary tract or other infection screening, including urinary incontinence
  • Well-woman visits to get recommended services for women under 65

Covered Preventative Services for Children

  • Alcohol and drug use assessments for adolescents
  • Autism screening for children at 18 and 24 months
  • Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Bilirubin concentration screening for newborns
  • Blood pressure screening for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years
  • Blood screening for newborns
  • Cervical dysplasia screening for sexually active females
  • Depression screening for adolescents
  • Developmental screening for children under age 3
  • Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Fluoride chemoprevention supplements for children without fluoride in their water source
  • Fluoride varnish for all infants and children as soon as teeth are present
  • Gonorrhea preventive medication for the eyes of all newborns
  • Hearing screening for all newborns, and for children once between 11 and 14 years, once between 15 and 17 years, and once between 18 and 21 years
  • Height, weight, and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Hematocrit or hemoglobin screening for all children
  • Hemoglobinopathies or sickle cell screening for newborns
  • Hepatitis B screening for adolescents ages 11 to 17 years at high risk
  • HIV screening for adolescents at higher risk
  • Hypothyroidism screening for newborns
  • Immunization vaccines for children from birth to age 18 — doses, recommended ages and recommended populations vary: Diphtheria, Tetanus, Pertussis, Haemophilus influenza type B, Hepatitis A, Hepatitis B, Human Papillomavirus, Inactivated Poliovirus, Influenza (Flu Shot), Measles, Meningococcal, Pneumococcal, Rotavirus and Varicella
  • Iron supplements for children ages 6 to 12 months at risk for anemia
  • Lead screening for children at risk of exposure
  • Maternal depression screening for mothers of infants at 1, 2, 4, and 6-month visits
  • Medical history for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Obesity screening and counseling
  • Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
  • Phenylketonuria (PKU) screening for this genetic disorder in newborns
  • Sexually transmitted infection (STI) prevention counseling and screening for adolescents at higher risk
  • Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
  • Vision screening for all children.

 

Read on for more information on minor medical insurance plans and what they cover.

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Navigating Individual and Voluntary Benefits

Navigating the similarities and differences between individual and voluntary benefits can seem challenging. Which ones do your employees want? What can employees get from individual benefits that they can’t from voluntary? How can benefits attract and retain great talent?

 

Here is a list of the major similarities and differences between the two to help you navigate what benefits you want to provide.

Similarities 

  • Customizable options: Both benefit options have multiple coverage options available. These customizations give people the ability to change their options to cater to their needs, their family size, and their budget.
  • Dependent coverage: You have the ability to add eligible dependents, like your spouse and children, for an additional charge.
  • There are various areas that are covered: Both types of insurance cover dental, vision, disability, and life insurance.

Differences 

  • Voluntary benefits are sponsored by your employer: Voluntary benefits are only offered through employer-sponsored healthcare plans. Those who are not employed do not have access to voluntary benefit options. The employer also chooses what options are offered and what the coverage levels are. As an employer, this can be a great way to differentiate your company.
  • Individual insurance is completely paid for by an employee: Some business owners pass the cost of voluntary benefits on to their employees, though it is not required. Some employers will also cover a portion of voluntary benefit elections for their employees. With individual coverage, the employees take the entire cost.

At Innovative HIA, we understand how important your employees are to your organization. Offer your employees the most options for coverage. When you offer your employees more options when it comes to benefits, they will likely have higher engagement levels as they feel you care for their wellbeing. Contact us to learn more about the voluntary benefits you can offer your employees.

 

Read on to learn more about how you can add value to your existing benefits plans. 

 

Article originally published on SBMA Benefits.

infographic on how to navigate individual and voluntary benefits

Pregnancy and Minimum Essential Coverage

Innovative HIA’s Minor Medical plan (also known as Minimum Essential Coverage) provides expecting mothers the resources to screen for potential risk factors that impact the mother and baby. Some conditions or complications that arise during pregnancy are not easily recognizable and may require screening and testing for a diagnosis. It’s important to routinely check on you and your baby’s health so that if complications arise, your healthcare team is prepared to support your prenatal care. Learn more about pregnancy and minimum essential coverage – what we cover and why it’s important for you and your baby’s health in the short and long term. 

What Does Our Minimum Essential Coverage Plan Include for Pregnant Women? 

  • Anemia screening on a routine basis for pregnant women 
  • Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women
  • Gestational diabetes screening for women 24 to 28 weeks pregnant and those at risk of developing gestational diabetes
  • Hepatitis B screening for pregnant women at their first prenatal visit 
  • Preeclampsia prevention and screening for pregnant women and follow-up testing for women at higher risk 
  • Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk 
  • Syphilis screening for all pregnant women or other women at increased risk 
  • Tobacco use screening and interventions for all women, and expanded counseling for pregnant tobacco users 

What is Anemia? 

Anemia is a blood condition where the blood does not have sufficient healthy red blood cells in the body. Red blood cells carry oxygen to your organs and your baby. This means, that reduced levels of red blood cells cause lower levels of oxygen going to your body’s organs and your baby. Symptoms can include fatigue, weakness, and dizziness. 

During pregnancy, there are three types of anemia that can develop:

  • Iron-deficiency anemia
  • Folate-deficiency anemia 
  • Vitamin B12 deficiency

The most common type of anemia during pregnancy is iron-deficient anemia. In iron-deficiency anemia, the blood cells do not have enough iron in them to create sufficient amounts of the protein hemoglobin that carries oxygen itself on the red blood cell.

Therefore, the red blood cells cannot carry as much oxygen to the organs in the body, or the baby. Think of it like a train. The train with six carriages will transport double the amount of people in the same amount of time that a three-carriage train can.

Folate-deficiency anemia occurs when there isn’t enough intake of vitamin folate. Folate is a B vitamin found in food like broccoli and kale. It’s the basis for the body to make healthy red blood cells that can carry oxygen. Maintaining a consistently balanced diet replenishes folate levels in the body. 

Vitamin B12 also helps the body create healthy red blood cells. Vitamin B12 deficiency limits the body’s ability to produce healthy red blood cells that circulate enough oxygen to you and your baby. Sources of B12 are found in meat, fish, and dairy products. Again, maintaining a well-balanced diet helps protect you and your baby from potential birth complications. 

Why is Screening Important?

When screened for anemia, the test usually includes a hemoglobin test that measures the amount of iron-rich protein in the red blood cells and a hematocrit test that measures the percent of red blood cells in a blood sample. 

Severe untreated anemia can lead to pregnancy complications and potentially preterm delivery. We cover anemia screening because we know the importance of catching and monitoring anemia during pregnancy for you and your baby’s safety. 

Breastfeeding Support for Pregnant Women

After delivery, one of the first ways to assist women is through breastfeeding support and counseling. Both the American Academy of Pediatrics and the World Health Organization recommend women exclusively breastfeed infants for the first six months. 

For women who choose to breastfeed their infant, our Minor Medical plan provides breastfeeding comprehensive support and counseling from trained providers. The support includes access to breastfeeding supplies for pregnant and nursing women. 

According to the CDC, “research has shown that breastfeeding is recognized as the best source of nutrition for most infants.” 

Breastfeeding counseling encourages and supports mothers during the breastfeeding process. They help the mother:

  • Correct breastfeeding positioning, attachment, and effective suckling. 
  • Educate the mother on typical feeding behavior such as eating up to eight times a day, and signs such as rooting for when the baby is hungry. 
  • Encourage the mother to switch the breast used after each feeding.
  • Reassure the mother that she will produce enough milk for her baby. 

We encourage the use of trained providers through our Minor Medical benefits to plan to support mother and child during the important feeding process.  

What is Gestational Diabetes and Why is Screening Important?

Our Minor Medical benefits plan covers gestational diabetes screening during the second trimester and for women at risk of developing gestational diabetes. During the 24-28 week period, the second trimester of pregnancy, the pregnant woman’s body is more resistant to insulin which makes glucose, sugar, and levels rise. Women who are obese before pregnancy, or have a family history of diabetes, are at a higher risk of gestational diabetes, which makes it important for them to receive screening as well. 

Screening typically includes: 

  • Initial glucose challenge test – you drink a sugary solution and your blood is monitored an hour later to check if the levels are normal or out of range.
  • Follow-up glucose tolerance test – if the first glucose test was high, a second glucose tolerance test is taken. This one requires blood level monitoring every hour for three hours. 

It’s important to screen for gestational diabetes so you can prevent any possible future complications. If diagnosed, you and your provider can develop a treatment plan for you and your baby and monitor your health.  

Complications for the baby:

  • Excessive birth weight
  • Preterm birth 
  • Breathing difficulties 
  • Low blood sugar 
  • Obesity or type 2 diabetes later in life 
  • Stillbirths 

Complications for the pregnant woman:

  • High blood pressure 
  • Preeclampsia 
  • C-section 
  • Future diabetes 

Screening for gestational diabetes allows the mother and child to obtain the resources necessary to reduce complications in the future. 

Read on for more information about minimum essential coverage.

Infographic about Pregnancy and Minimum Essential Coverage

Attention Brokers: Are You Offering Your ALE Clients the Most Affordable MEC?

Attention Brokers: Are you offering your ALE clients the most affordable Minor Medical Coverage (MEC)? How can you offer your applicable large employers a one-stop shop for all their needs? Benefits are no longer about simply meeting Minimum Essential Coverage options.  You need to offer worksite and voluntary benefits, telehealth options, call center availability, and easy portal management. Why should you offer these options to your employers? Because they want them.

In order for employers to attract and retain great talent, they need great benefit options. This means going beyond standard Minor Medical requirements and offering services that provide value and attract the best workers.

Let’s Start with Voluntary Benefits

Worksite and voluntary benefits include accident insurance, term life insurance, critical illness insurance, and hospital indemnity.

  • Accident insurance includes aid in payment for medical and out-of-pocket expenses that may occur due to an accident occurring.
  • Term life insurance includes a way to provide financial protection for loved ones while employees are working.
  • Critical illness insurance adds a safety net for those who are under-insured.
  • Hospital indemnity benefits help to offset high deductibles and out-of-pocket expenses so a hospital stay does not become a financial crisis.

Next, Consider Offering Your Employees Access to Telehealth Care 

With 24/7 access to doctors, telehealth–also known as Virtual Health–can help employees get care when they need it with added convenience. At Innovative HIA, we offer telehealth options that include behavioral health and therapy access, to give employees the ability to speak to a therapist whenever they need it.* In addition, it helps employees receive necessary prescriptions without having to go to a doctor’s office.

Employers look for convenience when looking for benefits, as a broker you can provide a one-stop-shop for all your ALEs benefits needs. This means 24/7 call center support and easy access to portal management, single-point billing, and US-based customer care.

At Innovative HIA, we offer portal management access to provide employers with the ability to make plan changes, order ID cards, and have them shipped within a few days, check their claim statuses, and give employees the ability to manage their own profiles.

With bilingual call center support, you’re getting licensed representatives to help manage enrollment and provide year-round support. All of our representatives are in-house, which means they understand your client’s needs.

Innovative HIA can provide a one-stop shop for all employers to handle their benefit needs. As a broker, it is your responsibility to provide your employers with the best possible options for their needs. Contact us to learn more!

For more information on how we support employee benefits administration, read our article here. 

Article originally published on SBMA Benefits. 

offer your clients the best mec plan

What is Minor Medical and What Does It Cover?

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